Healthcare Provider Details

I. General information

NPI: 1003560731
Provider Name (Legal Business Name): ERIN VAN SAMBEEK ERNST RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 HIGHLAND AVE
MADISON WI
53792-0002
US

IV. Provider business mailing address

7433 OLD SAUK RD UNIT 303
MADISON WI
53717-1256
US

V. Phone/Fax

Practice location:
  • Phone: 608-890-8227
  • Fax:
Mailing address:
  • Phone: 920-213-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number192081-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: